2018-2019 Goldsmith Early Childhood Center Registration

We look forward to having your child(ren) in our program for the 2018-2019 school year. The form below will guide you through our online enrollment application. Enrollment is accepted on a first-come, first-serve basis. If your desired class is unavailable, you will be contacted with alternative choices.

The registration deposit for each child is $310, which will be credited towards your full tuition. The link will automatically direct you to our payment portal. Please note that your registration is not complete without the deposit payment.

We are in the midst of our Goldsmith Early Childhood Center "Operation Facelift" and know that you will enjoy the improvements, new furnishings, and new ideas that the 2018-2019 school year will bring.

Shalom,Michelle Gold, Director

Parent #1 Name*

FirstLast

Parent #1 Cell Phone*

Parent #1 Home Phone*

Parent #1 Work Phone

Parent #1 Email Address*

This is also the email address at which you would like to be contacted.

Parent #1 Mailing Address*

This is the primary mailing address for the student.

Street AddressAddress Line 2CityStateZIP Code

Parent #2 Name

FirstLast

Parent #2 Cell Phone

Parent #2 Home Phone

Parent #2 Work Phone

Parent #2 Email Address

Does Parent #2 have a separate mailing address?

Yes

No

Parent #2 Mailing Address*

Street AddressAddress Line 2CityStateZIP Code

Emergency Contact Name*

Please enter an emergency contact in case we are unable to reach you directly.

FirstLast

Emergency Contact Phone*

Emergency Contact Email Address*

Do you have any other children in Chizuk Amuno schools?*

Yes

No

In which other schools do you have children enrolled?*

Krieger Schechter Day School

Rosenbloom Religious School

Achshav or Netivon High School

Are you members of Chizuk Amuno?*

Yes, we are members of Chizuk Amuno Congregation

No, we are members of another synagogue or unaffiliated

Of which synagogue are you a member?

Would you like someone to contact you regarding membership at Chizuk Amuno?*

Yes, please contact me regarding Chizuk Amuno membership

No thanks, I am not interested in membership at this time

Child #1 Name*

FirstLast

Child #1 Hebrew Name

Name

Child #1 Birthday*

Child #1 Gender*

Male

Female

Child #1 Allergy, Dietary, and Medical Information*

Does your child have any special allergy, dietary, or medical needs that the school should be aware of? If yes, please use the space below to expand.

No health concerns

Child #1 Program Selection - Chizuk Amuno Member*

The full tuition is listed next to each class. Please note that only the $310 deposit will be charged at this time.

Child #1 Program Selection - Member of Another Synagogue/Unaffiliated*

The full tuition is listed next to each class. Please note that only the $310 deposit will be charged at this time.

Child #1 Early Arrival

Early Arrival is available from 7:30am-9:00am, Monday-Friday, for $280 per day selected. Each day selection covers the entire 2018-2019 school year. Early Arrival will also be available on an "as-needed" basis for $15 daily. This item will not be charged upon completion of this registration. Please note there is no substituting once selections have been made.

Monday ($280)

Tuesday ($280)

Wednesday ($280)

Thursday ($280)

Friday ($280)

KSDS FAMILIES ONLY - Monday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Tuesday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Wednesday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Thursday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Friday, 7:30am-8:15am ($125)

Child #1 Extended Stay

Extended Stay is available from 3:00pm-6:00pm, Monday-Thursday, and 3:00pm-5:00pm on Friday, for $565 per day selected. Each day selection covers the entire 2018-2019 school year. This item will not be charged upon completion of this registration. Please note there is no substituting once selections have been made.

Monday ($565)

Tuesday ($565)

Wednesday ($565)

Thursday ($565)

Friday ($565)

Are you interested in enrolling a second child today?*

Yes

No

Child #2 Name*

FirstLast

Child #2 Hebrew Name

Name

Child #2 Birthday*

Child #2 Gender*

Male

Female

Child #2 Allergy, Dietary, and Medical Information*

Does your child have any special allergy, dietary, or medical needs that the school should be aware of? If yes, please use the space below to expand.

No health concerns

Child #2 Program Selection - Chizuk Amuno Member*

The full tuition is listed next to each class. Please note that only the $310 deposit will be charged at this time.

Child #2 Program Selection - Member of Another Synagogue/Unaffiliated*

The full tuition is listed next to each class. Please note that only the $310 deposit will be charged at this time.

Child #2 Early Arrival

Early Arrival is available from 7:30am-9:00am, Monday-Friday, for $280 per day selected. Each day selection covers the entire 2018-2019 school year. Early Arrival will also be available on an "as-needed" basis for $15 daily. This item will not be charged upon completion of this registration. Please note there is no substituting once selections have been made.

Monday ($280)

Tuesday ($280)

Wednesday ($280)

Thursday ($280)

Friday ($280)

KSDS FAMILIES ONLY - Monday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Tuesday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Wednesday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Thursday, 7:30am-8:15am ($125)

KSDS FAMILIES ONLY - Friday, 7:30am-8:15am ($125)

Child #2 Extended Stay

Extended Stay is available from 3:00pm-6:00pm, Monday-Thursday, and 3:00pm-5:00pm on Friday, for $565 per day selected. Each day selection covers the entire 2018-2019 school year. This item will not be charged upon completion of this registration. Please note there is no substituting once selections have been made.

Monday ($565)

Tuesday ($565)

Wednesday ($565)

Thursday ($565)

Friday ($565)

Photo Release*

I hereby allow Chizuk Amuno Congregation (CAC) to use print and digital pictures and videos of my child(ren) taken at CAC events in digital and print publicity and marketing for Chizuk Amuno and Goldsmith Early Childhood Center. I understand that my child's full name will NEVER appear next to his/her picture and the pictures will only be used to promote CAC and Goldsmith Early Childhood Center or for educational materials.

Yes, I give permission for my child(ren)'s image to be used as described above